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What is Holding You Back from an EHR
Revolution?
Session PE4, February 11, 2019
Taylor Davis, VP of Innovation, KLAS
Christopher Sharp, CMIO, Stanford Health Care
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Taylor Davis, KLAS
Manages the KLAS Arch Collaborative and is an employee of KLAS.
Christopher Sharp, Stanford University School of Medicine
Has no conflicts of interest.
Conflict of Interest
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Impact and scope of burnout on medicine
Framework for combatting burnout
How the EHR impacts burnout (and visa versa)
Variation drivers in EHR success
Framework for EHR success
Agenda
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Inspect the learnings of both the Stanford WellMD and KLAS Arch
Collaborative research efforts to understand the common
principles that lead to decreased physician burnout and greater
EHR success.
Review specific case studies of successful provider organizations
who have created greater EHR mastery in their EHR users,
connecting this greater mastery to better clinician fulfillment.
Debunk many of the common myths that organizations have
regrading creating EHR success and decreasing burnout.
Review a checklist that organizations can use to measure their
own EHR success readiness and progress towards decreased
burnout.
Learning Objectives
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What’s Happening to Doctors?
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Burnout is a syndrome of depersonalization,
emotional exhaustion, and low personal
accomplishment that leads to decreased
effectiveness at work.
What is Burnout?
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Burnout by Specialty 2011
N=7288
Shanafelt et al, JAMA Int Med 172:1137
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Burnout in the U.S.: Physicians &
Population
Shanafelt TD et al. Mayo Clinic Proceedings. 2015 90:1600
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Stanford Physician Well-Being
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Trockel and colleagues 2017
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Well Physicians = Higher Performance
Physicians Who are Well:
Higher patient satisfaction (Beach, et al. 2013)
More likely to support preventive health
practices in patients (Duperly, et al., 2009; Frank, et
al., 2008; Frank, et al. 2013)
Lower medical error rate (Fahrenkoph, et al. 2008;
Shanfelt, et al. 2010; West, et al. 2006)
Better patient outcomes, e.g.
decreased post-hospital discharge
recovery times (Halbesleben and Rathert, 2008)
Less likely to leave their organization
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What is the value ($$) of wellness?
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The Business Case for Investing in Physician Well-being. Shanafelt T, Goh J, Sinsky C.
JAMA Intern Med. 2017 Dec 01;177(12):1826-1832.
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Lower
Costs
Improved
Patient
Care
Clinician
Well-being
Better
Outcomes
Achieving our mission is no longer possible
without addressing wellness
Fourth
Aim
Bodenheimer, Ann Fam Med 12:573
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Aiming for Professional Fulfillment
Bohman, NEJM Catalyst 2016
Leadership
Values Alignment
Voice/input
Meaning in work
Community/collegialit
y
Peer Support
Appreciation
Flexibility
Culture compassion
EHR usability
Triage
Scheduling
Patient portal
Documentation
method
Team-based care
OR turnaround
times
Staffing
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What is the role of health information
technology?
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How the EHR Contributes to Burnout
Toll, E. The Cost of Technology. JAMA.
2012;307(23):2497-2498.
Usability /
User
Interface
Built-in
Regulatory &
Documentation
Requirements
Effect on
Interpersonal
Interactions
Shift in
Workload to
Providers
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It’s About Time
For every hour physicians provide direct clinical face time,
nearly 2 additional hours is spent on EHR and desk work
EHR time while face-to-face is equal to “Desktop Medicine”
(patient messages, refills, ordering tests, reviewing results)
While in the room with patients, physicians spent ~50% on
direct clinical face time and ~40% on EHR and desk work
Sinsky C, et al. Allocation of physician time in ambulatory practice: a time
and motion study in 4 specialties. Ann Intern Med. 2016;165:753-60.
Tai-Seale M, et al. Electronic Health Record Logs Indicate That Physicians
Split Time Evenly. Health Aff (Millwood). 2017 Apr 01;36(4):655-662.
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My Internal Medicine Clinic
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Minutes per Day (Unscheduled Days)
Minutes per Day (7pm-7am Activity on Scheduled Days)
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Ambulatory Physician
Optimization Program
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Participation
Offered to 600+ providers with 84% participation
94% of participants are “likely to recommend”
Includes faculty and community physicians
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Matthew Hiller
Mona Sidhu
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2%
15%
19%
17%
34%
32%
80%
51%
49%
Impacts
4%
25%
30%
24%
46%
38%
72%
29%
32%
Initial Survey Data - Satisfaction
(N=343)
Post 30 Day Follow-up Survey - Satisfaction
(N=86)
Satisfaction with EHR
Proficiency Using EHR
Initial Survey Data - Competence
(N=343)
Post 30 Day Follow-up Survey - Competence
(N=86)
Excellent / Very Good
Good
Poor / Fair
Satisfaction with Clinical Work
Initial Survey Data Clinical Satisfaction
(N=101)
Post 30 Day Follow-up Survey Clinical Satisfaction
(N=101)
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Looking forward
Usability /
User
Interface
Regulatory &
Documentation
Requirements
Enhanced
Interpersonal
Interactions
Team-based
Care
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Key Finding:
The EHR is often
perceived as a driver of
burnout.
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Click to edit Master title style
Burnout vs. Net EHR Experience Score
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167 organizations
Over 70,000 clinical responses
Same EHR questions . . .
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Do you agree that
your EHR enables
you to deliver high-
quality care?
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Where Does the Variation Come
From?
© Copyright KLAS 2019
From the EHR
Vendor?
From the
Provider Organization?
From the
Clinician Users?
Engage Deeper With
Individual Clinicians
Improve EHR
Development
Improve
Implementation
& Configuration
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© Copyright KLAS 2019
60%
18%
22%
Where Does the Variation Come
From?
From the
EHR Vendor?
From the
Provider
Organization?
From the
Clinician
Users?
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73% of organizations have two
physicians
of the same specialty
using the same EHR
One physician
STRONGLY DISAGREES
the EHR enables them to
deliver high-quality
healthcare.
One physician
STRONGLY AGREES
the EHR enables them to
deliver high-quality
healthcare.
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Click to edit Master title style
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© Copyright KLAS 2019
You have reported high satisfaction. What
do you believe you do differently from some
of your peers that enables you to be highly
successful with the EHR?
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Click to edit Master title style
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© Copyright KLAS 2019
KLAS Team Favorite Answer:
“I am smarter than they are.”
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Click to edit Master title style
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© Copyright KLAS 2019
Second Favorite Answer
“Maybe lower expectations?”
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What Makes a Successful EHR User?
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Click to edit Master title style
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© Copyright KLAS 2019
Initial Training vs. EHR Experience
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Click to edit Master title style
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© Copyright KLAS 2019
Personalization Adoption vs. EHR
Experience
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Click to edit Master title style
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Organization Trust vs. EHR
Experience
© Copyright KLAS 2018
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Case Study: OrthoVirginia Sees Huge Satisfaction Improvement
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taylor.davis@klasresearch.com
@TAYLORatKLAS
csharp@stanfordhealthcare.org
@tophersharp
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